As employers stop footing the bill for drugs such as Wegovy and Zepbound, more patients are turning to direct-to-consumer (DTC) prescription programs. That puts Walmart, Costco, CVS and Amazon in a position to capture a bigger slice of this market, and their moves could punish independent pharmacies.
For large retailers and pharmacy chains, a GLP-1 prescription has become more than a one-off transaction; it is a base for long-term customer ties. Each monthly refill is another chance for shoppers to fill their carts with groceries and other merchandise.
Eric Bormel of Solomon Partners said, "Retailers are betting that if they can become the front door for obesity care, they'll earn a relationship that extends far beyond a single GLP-1 prescription." DTC programs are customer acquisition tools, and the surrounding services matter more to retailers than the drug itself, whose price is under pressure. "Everyone recognizes that obesity treatment is becoming a longitudinal consumer relationship," Bormel said, adding that these programs are drawing in new patients rather than simply redistributing existing ones.
Jackie Swanson of Gartner Consulting said, "In a retail industry that spends billions chasing foot traffic, that is the most reliable recurring customer relationship on the market." She added, "Pharmacy lock-in is loyalty-program economics applied to medicine, and it works because the refill, unlike almost everything else in retail, is non-negotiable." She noted that LillyDirect's monthly cash price is $299 to $449, and customers get better rates if they refill within 45 days. "Which is a loyalty program dressed as a discount schedule," Swanson said. Walmart's role as LillyDirect's in-store pickup site is significant because customers must pass through the store when retrieving their medicine.
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Novo Nordisk's NovoCare has a $199 introductory price that later steps up to $349, a "classic acquisition funnel," Swanson said. Through its Sesame tie-up, Costco charges about $349 for Wegovy and requires a membership. "So the prescription now helps sell the $65 card," Swanson said.
"When a discount is tied to a network, the patient's choice of pharmacy happens at sign-up, not at the counter, and that's a meaningful change for any pharmacy that has historically won business through service and proximity. The economics of these programs favor scale," Swanson said. "The retailer that fills the prescription tends to sell the groceries too, and pharmacy is quietly becoming the membership battleground of American retail."
Walmart, which operates nearly 4,600 pharmacies and ranks as the fifth-biggest U.S. prescription provider, broadened its Better Care Services online hub in April to tie GLP-1 prescriptions to nutrition counseling, exercise apps, and AI-based coaching tools. It holds 4.8% of the pharmacy market, behind CVS's 14.7% and Walgreens' 14.6%, according to Drug Channels Institute.
Amazon rolled out a GLP-1 management service via Amazon One Medical and Amazon Pharmacy. Insured patients pay as little as $25 a month and get same-day delivery in nearly 3,000 cities, with expansion to 4,500 by year-end. Money from big-box chains is pouring into digital weight-management hubs, telehealth obesity clinics, dietitian services, and corporate care-management offerings.
These programs reflect the commercial stakes behind weight-loss drugs: with monthly cash-pay prices in the $199-to-$449 range, drugmakers have built direct-to-consumer portals and discount schedules tied to refills. For retailers, the monthly refill is a way to turn that prescription into routine foot traffic.
In 2024, Walmart shut down all 51 of its Walmart Health center locations and ended the virtual care service, closing out the offering across six states. In late 2022, Amazon discontinued Amazon Care only weeks after unveiling its $3.9 billion acquisition of One Medical; years before, it had walked away from Haven, a healthcare collaboration formed alongside JPMorgan Chase and Berkshire Hathaway that collapsed in 2021 without delivering the savings the three companies had pledged. CVS, meanwhile, has closed a large number of its store-based Minute Clinic sites and has struggled to produce the same profit from healthcare as it does from paper towels or back-to-school supplies.
In 2023, Walmart's then-CEO Doug McMillon said the company expected weight-loss drugs to help drive sales. Kroger CEO Rodney McMullen said at that time, "Sales dollars are a lot bigger than the margin dollars," and "The impact on profitability is pretty narrow."
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